Implications for Policy and Programming: Reflections from the RENEWAL Study, 2008 Presentation Transcript
Implications for Policy and Programming: Reflections from the RENEWAL Study, 2008 Scott Drimie, Girma Kassie & Jo Vearey University of the Witwatersrand Forced Migration Studies Programme Health and Migration Initiative
Urban complexity opportunities for aligned policy responses
Tiers of government: local – provincial – national – regional - global
Studies Confirm Complex Urban Rural Linkages
Nutrition and Informal Settlements
Implications for policy and programming
Johannesburg as a case study
Urban informal settlements have double the HIV prevalence of urban formal areas in South Africa
Dietary Diversity Score
A variety of foods in the diet is required to ensure an adequate intake of essential nutrients . Dietary diversity reflects the number of foods or food groups eaten over a reference period.
Dietary diversity can be used as an indicator of micro-nutrient adequacy (Steyn et al 2006), and as a proxy measure of the nutritional quality of the diet (Swindale and Bilinsky 2005).
Dietary diversity scores have been positively associated with the nutritional status of young children (Arimond and Ruel 2004) and adults (Savy et al 2007), independent of socio-economic factors.
Dietary Diversity Score:
Dietary Diversity Score: respondents residing informally were more likely to have a deficient dietary score Chi-square 89.880; p = <0.0001 Score 0 - 3 Score 4 - 6 Score 7 - 9 24 hour Dietary Diversity Score
[1 GAIn, 2009 ; Steyn et al. 2005 ; Kruger et al. 2007 Comparison of stunting (low height-for-age) for children aged 1-9 years nationally and by area of residence: South Africa 1999 and 2005 Steyn et al (2006) showed a strong relationship between dietary diversity and child growth for South African children.
An Inadequate Diet: Some Issues
Refined foods among lowest cost sources of energy; more nutrient dense foods (lean meat, vegetables and fruit) are more costly.
In 2006 many healthier food items were 50% more expensive than comparable less healthy ones.
Low-income people will often select a diet with a high content of refined cereals, sugar and fat (Temple & Steyn, 2009).
Suggests economic factors may lead to selection of unhealthy diet. However, other factors such as taste and convenience are important.
Implications of an Inadequate Diet
High content of sugar and fat in cheap, less healthy foods causes them to have high energy density (ED)
Many investigators speculate that diets with high ED may be responsible for high prevalence of obesity in people of low socio-economic status.
South Africa has a high prevalence of both under-nutrition (micronutrient deficiencies in infants and children) and over-nutrition. Poor quality of available food may contribute to both conditions.
HIV/AIDS and nutrition are inextricably interrelated, particularly in Africa
Malnutrition and food insecurity are endemic in Africa, where more than 25 million people are living with HIV
Nearly 40% of African children < 5 are moderately or severely stunted
> 50% also suffer from micronutrient deficiency disorders
Malnutrition is not limited to children
> 50% of all pregnant women are anemic
What can be done?
Food access: costs of improving diets a challenge.
Temple and Steyn, 2009:
Extra cost of a healthier diet was roughly R198 per month, an amount that represents between 10% and 20% of the entire family budget (Khayelitsha, South Africa)
Based on food price data collected in 2006.
Short sighted to advise people to change diets if unaffordable.
What can be done?
Food availability: urban agriculture may contribute to urban diets
Major challenges in Johannesburg and Windhoek:
Cost of water, availability of land, weak extension/ support, weak markets, spatial planning (“Apartheid City”), poor sectoral integration
However, there seems to be growing interest (food prices) and there are important lessons from Addis Ababa
Short sighted to advise people to change diets if unaffordable
What can be done?
Food utilisation: Health promotion messages formulated to advise selection of foods that are healthy and affordable – including maize meal, oats, lentils, rice, dry beans, vegetables and fruit.
But what about broader structural issues? – challenge of addressing the reality of food prices. Address through:
Taxation? Subsidies? Disincentives for price collusion?
These elements of food insecurity cannot be taken in isolation
An Aligned Approach?
Implications and challenges
Considering the interlinked livelihood systems, what interventions are required…….
To improve conditions for poor urban households to create sustainable livelihoods with positive health and food security outcomes?
To support poor urban households to mitigate the negative impact of chronic illness?